Joseph Kei

Prior to 2000, there were no efficient tests of middle ear function for neonates. There was a delay of 7 months in diagnosing middle ear effusion (MEE) in newborns. To address this shortcoming, my research program investigated the use of advanced technologies to detect MEE in newborns. To date, our research program has contributed to improving the health services, policy and guidelines for clinical practice in three phases as shown below.

(1) The successful application of high frequency tympanometry (HFT) to neonates did not only make detection of MEE earlier by 7 months, but it also facilitated early intervention to reduce the risk of chronic otitis media and eardrum perforation. My research team was the first in the world to publish the article, Kei et al. (2003), on the successful use of HFT with healthy newborns. This study has been cited 81 times in publications from 117 institutions around the world, including highly ranked universities such as Harvard Medical School and Albert Einstein College of Medicine of Yeshiva University. Subsequently, the Joint Committee on Infant Hearing (JCIH) Year 2007 Position statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs recommended the use of HFT with newborns. In 2012, I published a book [Kei, J. & Zhao, F. (Eds.) Assessing Middle Ear Function in Infants. San Diego: Plural Publishing] which describes all available methods to detect conductive conditions in infants. This book is being held in 1094 libraries worldwide (WorldCat, Feb 2024) and is currently a useful reference for postgraduate audiology students and clinicians around the world.

(2) Before 2009, the traditional acoustic stapedial reflex (ASR) test was not performed on newborns in any part of the world because it could not reliably predict MEE and auditory neuropathy spectrum disorders. I investigated the use of an advanced technology (high-frequency ASR test) with newborns and young infants, and published three articles at national and international journals from 2009 to 2012. In particular, the Kei (2012) article which established clinical guidelines and standards for testing neonates, attracted international attention and was cited in JCIH (2019), American Academy of Audiology Clinical Guidance Document: Assessment of Hearing in Infants and Young Children (2020), and World Health Organization & International Telecommunication Union (‎2019).

(3) Since 2009, I have been investigating the use of an innovative wideband absorbance (WBA) technology with neonates and infants in Australia. WBA tests are objective measures of outer/middle ear function across a range of frequencies from 0.25 to 8 kHz. WBA has been shown to be more sensitive than traditional tympanometry in the assessment of middle ear function in newborns and infants. Recent research in WBA has indicated age-related changes in middle ear function in children aged 0-13 years, suggesting that age-specific WBA norms are necessary for accurate detection of outer/middle ear diseases in children.

However, despite its merits, the uptake of the WBA technology by clinicians is low. One of the barriers to the widespread use of the technology by clinicians is the difficulty in interpreting WBA results. To tackle this problem, I have worked with imminent scientists from Australia, Canada and USA to publish a series of articles in Seminars in Hearing 2023: 44. Overall, my research in WBA has made a strong impact on the international policy and guidelines such as the JCIH (2019) and American Academy of Audiology Clinical Guidance Document (2020).